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Asian Journal of Surgery
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Asian Journal of Surgery
Letter to Editor
Giant androgen-producing adrenocortical carcinoma causing male characteristics
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Keywords: Adrenocortical carcinoma Androgen Surgical treatment
To the editor,
Adrenocortical carcinoma (ACC) is a highly malignant tumor, often with a poor prognosis, especially a giant tumor with a diam- eter of >20 cm. Here we present a case of giant adrenocortical car- cinoma with invasion of the renal capsule.
We herein reported a 64-year-old woman who was admitted to the hospital with dull pain in her left abdomen associated with hir- suteness, deep voice and multiple acne on her chest and back. On physical examination, an abdominal mass was present in the left region. CT scan revealed a huge mass about 18 cm*17 cm*13 cm in size in left retroperitoneum, which was indistinctly demarcated from the left kidney. The source of the retroperitoneal mass was un- clear, and the differential diagnosis included of a left adrenal mass, left upper pole renal mass, retroperitoneal sarcoma and other tu- mors. After biochemical tests, a functional adrenal work-up revealed that serum testosterone was 840.77 ng/dl and other hor- monal levels where within normal levels. Due to the size, external signs, biochemical function and location of the mass, an adrenocor- tical carcinoma was suspected. The patient underwent an open abdominal exploratory operation. After fully exposing the surgical area of the mass, which was noted to be densely adhered to the up- per pole of the left kidney with no surgical boundaries. We per- formed excision of the mass along with the left kidney under general anesthesia. The pathological examination showed that the mass originated from the adrenal gland, leading to adrenal cortical carcinoma and invading the renal capsule with the following immunochemistry profile: KI-67 (+), PCK (-), EMA (-), CD10 (-), Vim (+); MelanA (+), a-inhibin (+), Syn (+) (Fig. 1).
The patient was discharged 16 days after the operation.
ACC is a highly invasive endocrine tumor. The incidence in the population is 4-12 cases per million cases per year worldwide, affecting women more frequently than men.1 The 5-year survival rate varies from 15% to 84% and is directly correlated with the stage of the cancer at presentation.2 ACC can be divided into functional ACC and nonfunctional ACC according to whether the tumor could secret hormones.3 In our case, the mass comes from adrenal gland because of the following reasons. First, The patient had masculini- zation, such as beard, hairy. Second, hormonal abnormalities were discovered. Third, the size and location of the mass belongs to the adrenal region. Complete surgical resection carries the main treat- ment for cure in patients with ACC even in the presence of metas- tasis,4 which provides the possibility for long-term survival and against a recurrent attack on tissues and organs. Laparoscopic resection can be performed for patients with diameter of tumors <6 cm.5 Due to the giant mass, we finally decided to use surgical treatment with open adrenalectomy and complete resection with negative margins and sustained by chemotherapy.
In conclusion, sex hormone-producing adrenocortical carci- noma is rare and aggressive malignant tumor. Surgical treatment is the best choice for giant adrenocortical carcinoma with the excess of androgen. Postoperative adjuvant chemotherapy is needed when metastasis occurs.
Ethics approval
Ethics approval was granted from The First People’s Hospital of Longquanyi District Chengdu.
Consent to participate
Informed written consent was obtained from the patient for participation in this study and any accompanying images.
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Author contributions
Changyi Jiang, Conception and design of study, Drafting of manuscript and/or critical revision, Approval of final version of manuscript. Li Yin, Drafting of manuscript and/or critical revision, Approval of final version of manuscript, Acquisition of data. Qing- song Pu, Conception and design of study, Drafting of manuscript and/or critical revision, Approval of final version of manuscript.
Changxing Ke, Conception and design of study, Drafting of manu- script and/or critical revision, Approval of final version of manuscript.
Consent for publication
All authors have read and agreed to the published the manuscript.
Declaration of competing interest
The authors declare that there is no conflict of interest related to this report.
Acknowledgments
This study was supported by the Human Social Security of Yunnan Provincial “Ten Thousand Talents Plan” Training Program (YNWR-MY-2020-055).
References
1. Zheng Zhou, Luo Hong-Mei, Tang Jian, et al. Multidisciplinary team therapy for left giant adrenocortical carcinoma: a case report. World J Clin Cases. 2021;16(20):5737-5743, 9.
2. Mantzoros Ioannis, Bitsianis Stefanos, Loutzidou Lydia, et al. Giant adrenocortical carcinoma: a case report and review of the relevant literature. Am J Case Rep. 2021;4(22):e928875.
3. Else T, Kim AC, Sabolch A, et al. Adrenocortical carcinoma. Endocr Rev.
2014;35(2):282-326.
4. Estévez Fernández Sergio, Artime Rial María, Domínguez Comesaña Elías, et al. Giant adrenal cortical carcinoma. Cir Esp. 2017;95(9):542.
5. Jia K, Wei Y, Wang D, Ren S. Treatment of a case of adrenocortical sarcomatoid carcinoma. Asian J Surg. 2022 Nov;45(11):2576-2577.
Changyi Jiang1, Li Yin1, Qingsong Pu Department of Urology, The First People’s Hospital of Longquanyi District Chengdu, Sichuan, China
Changxing Ke*
Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
*
Corresponding author.
E-mail address: kenne126@126.com (C. Ke).
8 August 2023 Available online 28 October 2023
1 Changyi Jiang and Li Yin contributed equally to this study.